From the Guidelines
All premature infants born at or before 32 weeks gestational age should undergo Retinopathy of Prematurity (ROP) screening, with the first examination at 31-33 weeks postmenstrual age or 4 weeks chronological age, as recommended by the American Academy of Pediatrics, the American Academy of Ophthalmology, and the American Association for Pediatric Ophthalmology and Strabismus 1. The screening protocol is crucial for early detection and treatment of ROP, which can potentially prevent vision loss.
- The first screening examination should be performed by an ophthalmologist experienced in the evaluation of ROP in premature infants.
- Infants with more than 37 weeks of gestation at birth do not require screening, unless they have had a medically unstable course, such as supplemental oxygen requirement.
- The decision to screen infants between 29 and 37 weeks gestation should be based on their medical stability, with a more conservative approach being to screen all infants with less than 32 weeks of gestation at birth.
- Follow-up examinations are scheduled based on the findings at the first screening, with the frequency of subsequent examinations determined by the presence and severity of ROP.
- Parents should be informed about the importance of ROP screening and the potential benefits of early detection and treatment, as well as the temporary discomfort associated with the screening process 1.
From the Research
ROP Screening Protocol
The protocol for Retinopathy of Prematurity (ROP) screening in newborns involves regular eye examinations, with the timing and frequency depending on the infant's birth weight and gestational age.
- Infants born at less than 1500 g should receive regular ROP eye examinations starting at 4 weeks chronologic age or 31 weeks postconceptional age, whichever is later 2.
- The examinations should proceed every 1 to 2 weeks, sometimes even more frequently, until resolution of the ROP, or until treatment is needed 2.
- Extremely low birth weight (ELBW) infants should receive initial ROP screening using the chronological age guideline of 4 to 6 weeks rather than the 31- to 33-week postconceptional age guideline 3.
Screening Criteria
The Postnatal Growth and Retinopathy of Prematurity (G-ROP) screening criteria have been validated and can reduce the number of infants requiring examinations by 35.6% 4.
- Infants meeting one or more of the following criteria should undergo examinations: gestational age less than 28 weeks or birth weight less than 1051 g; weight gain less than 120 g during age 10 to 19 days, weight gain less than 180 g during age 20 to 29 days, or weight gain less than 170 g during age 30 to 39 days; or hydrocephalus 4.
- The G-ROP criteria have a sensitivity of 100% for type 1 ROP and can reduce the number of infants receiving examinations by 32.5% 4.
Screening Practices
Screening practices for ROP vary, and individual- and center-related factors can affect the likelihood of screening 5.
- Factors associated with screening include low gestational age, low birth weight, severe bronchopulmonary dysplasia or neurological lesions, and transfer between neonatal units during the screening period 5.
- The use of wide-angle imaging systems can increase the odds of screening, while the absence of a local protocol for ROP screening can decrease the odds 5.
Special Considerations
Small for gestational age (SGA) neonates may require earlier screening for ROP, as they can develop pre-threshold type 1 ROP before the recommended first screening time 6.
- SGA babies may need screening to start at 4 post-natal weeks, or be based on postmenstrual age rather than post-natal age, to allow timely laser therapy 6.